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16 Jan 2008 : Column 275WHcontinued
My hon. Friend the Member for Buckingham will deal in his review with the statementing system, which is still not fair or independent enough. Too many parents have to battle to get a diagnosis and an assessment, often at great personal expense to themselves and great financial expense to the local authority they are battling against. Once they have a ruling in their favour, they
have to battle yet further to get the support services to go with it. The system is a constant battle for too many people, and we should give those most in need as much help as possible by removing those hurdles.
I want to touch on two other issues. We have spoken a lot about physical disabilities, but we must not forget learning and communication disabilities. I CAN is a leading charity in that field: I pay tribute to its excellent work and welcome its input into the review by my hon. Friend the Member for Buckingham. I CAN notes:
One in ten children...in the UK has communication problems that require specialist help. This represents approximately three children in every classroom...In some parts of the UK as many as 50 per cent. of five year olds are arriving at school without the speech and language they need to fully participate and achieve their potential at school. This figure rises to 80 per cent. in areas of high unemployment and poor housing.
It is therefore a false economy not to intervene early to ensure that children have the communication skills to enable them fully to take advantage of the education system and to integrate into it. I CAN goes on to say:
46.3 per cent. of children with a statement of SEN have identified speech, language and/or communication difficulties...Between 50 per cent. and 90 per cent. of people with learning disabilities have communication difficulties.
I CAN raises a few questions, which I want to leave with the Minister. First, it wants to know whether the childrens plan will ensure that childrens communication needs are given high priority. It notes that joint working, supporting parents and early intervention are important and it wants to know what the Government are doing to improve services for children with a communication disability. It also asks:
Has the Minister made any assessment as to how effectively Local Authorities and PCTs are able to commission services for children with speech and language difficulties and what are...the principles of effective commissioning in this area?
Many hon. Members would recognise from surgery cases a vicious triangle of passing the buck between the education authority, the PCT and perhaps childrens services and social services. The question of who should pick up the problem stems from the difficulty of assessing whether the child has a physical or a learning disability. Finally, Whizz-Kidz, a charity that does excellent work on child disability issuesit is particularly concerned with mobility and the 70,000 disabled children in the UK who need a wheelchairhas pointed out that there is an enormous postcode lottery for access to the specialised wheelchair provision on which many children rely. It has spent £2 million of charitable money on providing support services. I hope that the Minister will, in the short time available, provide some words of comfort about how seriously the Government take the problem of specialised wheelchair provision, particularly for the many disabled children throughout the country. Perhaps he would like to write to me in detail about that, because he has only 10 minutes in which to respond to the debate.
The Parliamentary Under-Secretary of State for Children, Schools and Families (Kevin Brennan):
I thank the hon. Member for East Worthing and Shoreham (Tim Loughton) for allowing me at least some time to respond to this important debate. Like other hon.
Members, I offer my thanks and congratulations to my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr. Clarke), for his work and commitment over the years in this important area and the passion and dedication with which he pursues the matters in question. Contributions to the debate were made by the hon. Member for Forest of Dean (Mr. Harper), my hon. Friend the Member for Blackpool, North and Fleetwood (Mrs. Humble), and the hon. Members for Edinburgh, West (John Barrett), and for East Worthing and Shoreham. There were interventions from my hon. Friend the Member for Ayr, Carrick and Cumnock (Sandra Osborne), the hon. Members for Buckingham (John Bercow), for South-West Devon (Mr. Streeter) and for Castle Point (Bob Spink), and my hon. Friends the Members for Dumfries and Galloway (Mr. Brown), for Edinburgh, North and Leith (Mark Lazarowicz), for Glasgow, North (Ann McKechin), and for Paisley and Renfrewshire, North (Jim Sheridan). All of them made important points, and I shall try as best I can in the short time available to deal with as many of them as possible before moving on, if I have time, to the set remarks that I had intended to make.
My right hon. Friend the Member for Coatbridge, Chryston and Bellshill raised the matter of money from Aiming high for disabled children, the Barnett consequential and the actions of the Scottish Executive in that regard. It is of course absolutely a matter for the Scottish Executive and Scottish Parliament to determine how much of the money generated from any Barnett consequential is used in any particular way; but in thinking that it is absolutely right for my right hon. Friend to press the matter in the UK Parliament, perhaps I disagree with what some Members have hinted at during the debate. It is absolutely the duty of MPs from all parts of the UK to point out issues, if they think that there is an injustice or that a wrong decision has been made by a local authority, a devolved Administration or another body. The needs of disabled children and their families are the same wherever they are in the UK.
Mrs. Humble: As an English MP, when undertaking our inquiry, I worked on behalf of disabled children throughout the UK; money went throughout the whole UK, so the services should follow throughout.
Kevin Brennan: I could not put the matter better, so I shall put it to rest at this point. My hon. Friend has clarified the point that I wanted to make in my comments on the speech of my right hon. Friend the Member for Coatbridge, Chryston and Bellshill.
Members raised the issue of patchy performance, and we shall shortly begin a tendering process for a national support body to support authorities with difficulties in implementing short-break services and to support our commitment to parent forums in all areas. For the first time there will be an indicator of parents experience of services for their disabled children. Parents will be surveyed locally on what they think. We will expect areas that perform poorly in that context to include the indicator in their local area agreements, stretch themselves and set out clearly how they will improve. There is a mechanism in place to try to do something about patchy performance.
Data collection was mentioned in the debate. Data collection and improving data is a key strand of Aiming high. We are setting up a working group with the Department of Health, local authorities and primary care trusts to consider how to improve local data on disabled populations and how they are used. We are also commissioning research on why there is such variation between local authorities in the quality of data, to inform future work and improve the responsiveness of services. The childrens plan sets out a commitment to improve special educational needs data in schools, so there will be some overlap with respect to outcomes for disabled children.
The hon. Member for Forest of Dean mentioned Gloucestershire and the financial situation there. He also mentioned the flooding in the region last summer. I visited Gloucestershire after the floods, and was happy to increase the grant from the Department for Children, Schools and Families from £600,000 to £1 million, which I know was welcomed in the county. The hon. Gentleman asked how we would learn the lessons from pathfinder areas such as Gloucestershire in relation to Aiming high for disabled children. Pathfinder areas must demonstrate their readiness ahead of receiving funding. That has happened, which is why they have been chosen.
Areas must demonstrate that the intention is to bring about a system change in the way they provide short breaks locally. The national support body will work with local authorities to make that happen, and ensure that best practice is shared and rolled out nationally. Following the pathfinder applications process, Capita is evaluating the information received from the applicants, which will inform the work of the support body in trying to learn the lessons.
My hon. Friend the Member for Blackpool, North and Fleetwoodshe tells me that one must always remember the Fleetwood bit in references to her constituencymentioned early intervention and integration. The need for early intervention in our services is a strong theme of the childrens plan, and I know that the Secretary of State is personally committed to it, as is shown by the work that he did on Aiming high for disabled children. We are very aware of the need for sustainability in relation to those services. I certainly make a commitment to look at the Select Committee report, as departmental colleagues will also want to do, in relation to disabled childrens issues, and I shall certainly ensure that Ministers look at it. My hon. Friend said that we have rather a lot of balls in the air at the moment; it is an analogy that we do not tend to use in front of the Secretary of Stateplate spinning might perhaps be a better image.
On PCT funding, disabled children are a welcome priority in the new NHS operating framework, which was announced recently. As is usual with national health service funding, the additional funding for short breaks is not separately identified, but my colleagues in the Department of Health and Lord Adonis in the Department for Children, Schools and Families have written to all PCTs emphasising the importance that we attach to joint working between local authorities and PCTs on improving short breaks.
Direct payments were mentioned in the debate. We recognise that they are not right for every family or child, and I think that families and hon. Members
share that view. Budgets supported by a broker are another way of trying to handle the issue of improving flexibility for disabled children and their families. We are developing a major communication strategy with the Council for Disabled Children to inform parents of the options available to them, both by way of direct payments and the use of a broker. I am keen that there should be opportunities to increase the uptake of disability payments where they are suitable for families and children.
The hon. Member for East Worthing and Shoreham raised the issue of speech, language and communications, and he will be very much aware of the review that is being undertaken by the hon. Member for Buckingham to address those questions. The hon. Gentleman will produce an interim report in March and a final report in the summer, which I hope will provide more detailed answers to the questions that have been raised in the debate.
We have had a useful and productive debate. Children are the Governments highest priority. With health, security and a good education, a child can achieve all that they are capable of, but without those things, they cannot do so. The Government have a duty to remove every barrier to success, particularly for disabled children.
Mr. David Kidney (Stafford) (Lab): It is a pleasure and a privilege to debate this important subject under your guiding hand, Mr. Cummings, and I look forward to the Ministers response.
There are good public health reasons why the activities of companies marketing breast-milk substitutes should be controlled, including the safety and health of new-born babies. Powdered formula is not sterile, so care needs to be taken over preparation to avoid contamination. Furthermore, the activities of companies should be controlled so as not to undermine efforts to promote breastfeeding.
The international standard for such control is the World Health Organisations international code on the marketing of breast-milk substitutes. The WHO is an organisation of member states, 118 of which, including the United Kingdom, voted to adopt the code as long ago as 1981; the United States of America was the only nation to vote against it. Ever since, we have been signed up to the WHO code and I dare say that Ministers have visited other countries and recommended it to them. However, our domestic law has not yet implemented the code and even though an opportunity to implement it has now arisen, the Minister has not proposed that we should do so.
I shall use the debate, therefore, to make representations to the Minister. It is not too late for us to be bolder and to implement fully the WHO code. We have a law to control the marketing activities of companies that make and sell infant formula, but it is widely recognised that it is not sufficiently effective. The debate comes at a time when the Minister is seeking to tighten that law to make it more effective. At present, I do not think that her proposal for changing the law takes us as far as it should, particularly towards full implementation of the WHO code. My purpose in this short debate is to urge her to go further.
My interest in the matter stems from my involvement in the public health arguments in favour of breastfeeding. Those arguments include a number of powerful facts. For example, babies breastfed for at least three months are at less risk of gastroenteritis; during the first six months of life, breastfed babies are five times less likely than formula-fed children to suffer from urinary tract infections; there is evidence that breastfeeding protects children from obesity in later years, and there is now extremely strong evidence that breastfeeding protects mothers against breast cancer and babies against excess weight gain, which is linked to an increased risk of cancer.
Such facts are common knowledge among health professionals and help to explain why the WHO and the Department of Health recommend that babies be exclusively breastfed for the first six months of their lives, yet in the UK only about 2 per cent. of babies are exclusively breastfed at six months. Breastfeeding is the healthiest and cheapest way to feed a baby, yet, at the other end of the equation, the UK has one of the lowest initial rates of breastfeeding in Europe.
I am no absolutist in my promotion of breastfeeding. I recognise that some parents rely on infant formula, because breastfeeding is not possible for a physical,
psychological or broader social reason. I would go further: this is a free country, so I accept that some parents will choose formula over breastfeeding for other reasons. Indeed, the WHO code recognises that there is a legitimate market for infant formula. However, it does not trust companies with a commercial interest in promoting their products to give out objective public health messages on matters of such importance.
Whether the issue is taking care not to undermine breastfeeding or ensuring the health and well-being of babies fed infant formula, the WHO says that the responsibility lies with Governments. Parents should be protected from partisan claims and should receive impartial advice and guidance, which is why I am a founding member of, and a parliamentary champion for, the breastfeeding manifesto coalition. It is an alliance of 39 organisations, including five royal colleges, trade unions, such as Unison, Unite and the Community Practitioners and Health Visitors Association, and hugely respected groups, such as the Baby Feeding Law Group, La Leche League, the National Childbirth Trust, Save the Children and UNICEF. The coalition also has broad support among all political parties in the House and another place. I am pleased to see the hon. Member for Mid-Dorset and North Poole (Annette Brooke) in the Chamber; she is one of the parliamentary supporters of the manifesto.
In my parliamentary experience of more than 10 years, I have always felt that, although the arguments about breastfeeding and public health matters are strong, they have not resonated as strongly in decision making as they ought to have done. I think that that is because the organisations that I have just named have not spoken with one voice. The development of the coalition, therefore, is significant in the promotion of arguments in favour of breastfeeding, and I hope that the Minister and her Department will benefit from knowing the views of those who share the Governments ambitions in promoting a healthy start to life for all children.
Those of us who support the manifesto look forward to living in a society where women feel enabled to initiate and continue breastfeeding for as long as they wish; where parents are supported in making informed choices about feeding their babies, and where everyone is aware of the significant benefits associated with breastfeeding. One of the manifestos seven key objectives is for our country to adopt the WHO international code on the marketing of breast-milk substitutes and subsequent relevant resolutions. The code acknowledges that manufacturers and distributors of breast-milk substitutes have an important and constructive role to play in infant feeding. Nevertheless, it states that Governments should have a responsibility to ensure that parents receive objective and consistent information on both breastfeeding and the safe and appropriate use of formula. The code specifically states that advertising and promotion by manufacturers and distributors should not be allowed.
Annette Brooke (Mid-Dorset and North Poole) (LD):
Does the hon. Gentleman agree that there is a proliferation in mother and baby magazines and other media of advertisements for follow-on milk, which many people believe are for mainstream breast-milk substitutes? Does he also agree that, in addition to the work of the organisations that he mentioned, it would
aid the debate if the Minister could commission independent advice on the impact and effect of those adverts?
Mr. Kidney: The hon. Lady puts her finger on possibly the most important issue that I wanted to raise, and makes a suggestion to the Minister that I hope we can pursue later in the debate.
Since 1995, the UK has had a law intended to protect parents from the promotion of formula milk. However, the law is not working; parents say that they constantly see adverts for formula milk. Companies promotional activities have simply become cleverer and more aggressive since 1995. In particular, they have realised, as the hon. Lady says, that they can legally advertise what they call follow-on formula for babies over the age of six months. They have cottoned on to a strategy of advertising that product that also promotes infant formula for younger babies, which is supposed to be illegal.
I have brought with me some examples of the type of adverts that the hon. Lady has just referred to, which were placed in magazines. I do not know whether the Minister is shown such adverts by her advisers when she is making policy decisions on the subject, but they are clear examples of that strategy in action. In one example, there are two adverts on the page, side by side. One advert goes into journals for professionals and promotes formula, which is not illegal. The other advert goes to magazines that parents would typically read and ostensibly it promotes the follow-on formula for babies over the age of six months. However, to look at the two adverts side by side is quite instructive, because, to the untrained eye, they are both the same and they are both promoting the same thing.
The current law, which is intended to protect the parents right to receive objective and accurate information about feeding their baby, is not working. Commercial pressure remains a factor in how parents decide to feed their children. After all, the market is big money for the companies. The UK market in formula milk nearly trebled from £119 million in 1995 to £329 million in 2006. During the increase in commercial pressure over that decade and more, parents have been increasingly influenced, as polls of women taken last year showed. For example, 60 per cent. of women polled said they had seen adverts that are supposed to be illegal and 89 per cent. said that they associated SMA with infant formula.
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